Despite advances in pharmacologic therapy for rheumatoid arthritis (RA), many patients continue to experience some measure of ongoing disease activity with the risk of developing resultant disability. Although measures aimed at identifying early active disease and controlling inflammation are essential, the disease itself and the drugs used for treatment may contribute to increased risks of cardiovascular disease, bone loss, and serious infection. Many of these risks can be substantially reduced by a range of preventive interventions. (See "Disease outcome and functional capacity in rheumatoid arthritis".)

A comprehensive management program for RA includes patient education; psychosocial interventions; appropriate use of rest, exercise, physical and occupational therapy; and nutritional and dietary counseling. The management program also includes interventions to reduce the risks of cardiovascular disease and osteoporosis, and immunizations to decrease the risk of infectious complications of immunosuppressive therapies.

The nonpharmacologic and preventive therapies used in the management of RA are presented here. An overview of the management of RA, including the stages of the disease, assessment of disease activity and severity, and pharmacologic management, is presented separately. (See "General principles of management of rheumatoid arthritis in adults".)

NONPHARMACOLOGIC AND PREVENTIVE THERAPIES

Patient education and counseling — Education and counseling are important in the management of rheumatoid arthritis (RA), a disorder in which therapy is continuous, using a mixture of modalities to maximize efficacy and reduce the risk of side effects [1]. Many patients have misconceptions about the nature of arthritis and its cause. Correcting these may help establish a good long-term relationship between the clinician and patient. The clinician can provide information concerning the therapeutic roles of physical therapy, medications, and surgery. A longitudinal plan should be developed with each patient that addresses prognosis and options for treatment [2,3]. Informed and sympathetic discussions concerning alternative, controversial, and unproven therapies are also important elements of patient education. (See "Complementary and alternative remedies for rheumatic disorders".)

Various psychosocial interventions can benefit patients with RA. A systematic review and metaanalysis of 13 trials, involving 1579 patients, has documented that psychosocial interventions can modestly reduce symptoms of fatigue [4]. Cognitive behavioral therapies may also significantly reduce the patient's self-reported pain, functional disabilities, joint involvement, disease activity, and feelings of low self-esteem [5]. One trial has shown that an online cognitive-behavioral, self-management program with weekly telephone support can improve self-efficacy and quality of life [6].

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